Healthcare Provider Details

I. General information

NPI: 1811252554
Provider Name (Legal Business Name): MELINDA CALLICOAT CROCI LPC, LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA K GREENBANK

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N SCOTTSDALE RD STE 145
SCOTTSDALE AZ
85257-3413
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE. 735
TEMPE AZ
85282-5691
US

V. Phone/Fax

Practice location:
  • Phone: 844-646-3247
  • Fax: 480-546-4048
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-14161
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-10349
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: